Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., and Rebecca Wartman, O.D.
From the May 2015 edition of AOA Focus, page 55.
AOA's Coding Experts share more solutions to your coding conundrums.
What is the appropriate ICD-10 code for bacterial conjunctivitis? I cannot find it under section H10 (Disorders of Conjunctiva)?
Just as there is no specific ICD-9 code for bacterial conjunctivitis, none exists in ICD-10. The H10 section delineates the options and it will take time to research the most appropriate one. A few examples are:
- Other mucopurulent conjunctivitis, right eye (H10.021).
- Other mucopurulent conjunctivitis, left eye (H10.022).
- Other mucopurulent conjunctivitis, bilateral (H10.023).
- Other mucopurulent conjunctivitis, unspecified eye (H10.029).
Viral conjunctivitis is listed under section B30 of the ICD-10 manual. By reviewing the "Diseases Index" of the AOA's 2015 Codes for Optometry book you can identify the section of the manual that the diagnosis is listed under. Then identify the cause of the bacterial conjunctivitis, if known. Be sure to review the exclusions
In terms of a patient who had an exam and presented with dry eye and allergic conjunctivitis, which of the two diagnoses is more appropriate to use
You should report the diagnosis that you understand to be the main reason or chief complaint that the patient came in for. If the patient's symptoms and chief complaint are related to dry eye, use that diagnosis. If the symptoms and complaint are related to allergy, report that diagnosis.
Does AOA have a simple cross walk from ICD-9 to ICD-10 codes?
As part of the AOA's ICD-10 coding resources, the AOA offers an express mapping card that can be found in AOA's Marketplace. However, it is critical to understand that the ICD-10 system is complex, and it's important for doctors of optometry and their staff to understand how the system is structured in order to correctly report patient diagnoses. This will require reviewing the disease and tabular lists of diagnoses, and being aware of exclusions and how to appropriately use other and unspecified codes. The AOA's coding experts developed a 10-part webinar series that provides doctors with this necessary guidance and instruction.
Ask the coding experts
If you have any questions regarding Medical Records and Coding, please submit them by using the Coding Experts Submission Form and one of our coding experts will be in contact with you.
Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2023, the AOA continues to press for Congress to act on reforms that would give doctors of optometry an annual, permanent inflationary Medicare payment tied to the Medicare Economic Index.
The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.